Abstract 14509: Isolated Tricuspid Valve Surgery is Safely Feasible in Carefully Selected Patients With Dilated Right Heart
Introduction: Patients with severe tricuspid regurgitation (TR) and right heart failure (RHF) are a heterogeneous group for whom surgery is considered high risk but for whom operability, risks, and benefits are still not well defined. Our objectives were to identify drivers and contributors to TR and right ventricular (RV) dysfunction, and to study outcomes related to degree of RV dysfunction and RHF after contemporary isolated tricuspid valve surgery (TVS).
Methods: From 1/2007 to 12/2013, 62 patients with severe TR, functional in 31 and structural in 31, and variable degree of RHF underwent isolated TVS. All had prior cardiac surgery. Preoperative cardiac catheterization and echocardiograms were reviewed to assess right heart morphology and function.
Results: At the time of surgery, increased right heart chamber dimensions and pressures were evident, but RV function was preserved (tricuspid anular plane systolic excursion 16.5 ± 5.86 mm, RV free wall strain -16.72% ± 5.82%, and RV S’ velocity 11.4 ± 4.76 cm/second). Preoperative Model for End-Stage Liver Disease score with sodium (MELDS) was 10.6 ± 4.37. Early outcomes showed no reoperation for bleeding or tamponade, 4.8% renal failure but no dialysis required, 13% prolonged ventilation (>24 h), and one hospital death for a respiratory complication (1.6%). In a sub-analysis, patients with preoperative functional TR were older, more volume overloaded, and had higher RV pressures and MELDS (p=.008) compared to patients with structural TR. There was no difference in RV function between patients with functional and structural TR. Patients with functional TR had more perioperative blood transfusions (p=.03), longer lengths of stay (p=.0002), and more prolonged ventilation (23% vs. 3.2% for those with structural TR).
Conclusion: Although isolated TVS in the setting of RHF has been associated with high risk of morbidity and mortality, our contemporary data show that it can be performed with low mortality and morbidity in selected patients with preserved RV function. Patients with functional TR are older and sicker and have a longer postoperative course than those with structural TR, but TR etiology still did not affect overall outcomes.
Author Disclosures: H. Elgharably: None. A. Ibrahim: None. L. Thuita: None. E. Blackstone: None. P. Collier: None. G. Pettersson: None.
- © 2016 by American Heart Association, Inc.